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. Post-operative care Using a criteria-based, evidence-based constructed approach to rehabilitation after ACL surgery is essential to systematically and successfully progress a patient through the rehabilitation process. 18 It is imperative to
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Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure.
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Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care.
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In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities. Other recognised pre-operative risk factors are urinary tract infections, intra-articular corticosteroid injections and nasal colonisation with Staphylococcus (S.) aureus, particularly the methicillin-resistant strain (MRSA).
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In the intra-operative setting, protective measures for PJI include antibiotic prophylaxis, surgical-site antisepsis and use of pre-admission chlorhexidine washing and pulsed lavage during surgery. In this setting, the use of plastic adhesive drapes and sterile stockinette, as well as using personal protection systems, do not clearly reduce the risk of infection. On the contrary, using sterile theatre light handles and splash basins as well as an increased traffic in the operating room are all associated with an increased risk for PJI.
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In the post-operative period, other infections causing transient bacteraemia, blood transfusion and poor wound care are considered as risk factors for PJI.
Cite this article: Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2016;1: 339-344 DOI: 10.1302/2058-5241.1.000032.
Service de Chirurgie Orthopédique, Traumatologie et Chirurgie Réparatrice des Membres, Hôpital d’Instruction des Armées Percy, France
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interventions that will lead to positive functional outcomes involves five main points, which will be discussed further. These include: understanding the disease background, pre-operative patient management, the surgical strategy, post-operative care, and the
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-tissue trauma. 23 Simultaneous bilateral THA Simultaneous bilateral THAs have varying results in the literature when performed using conventional post-operative care routines. Otte et al 24 did a small study on 50 consecutive fast
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high-power field in five high-power fields observed from histological analysis of peri-prosthetic tissue at ×400 magnification. Treatment Superficial wound infections are usually diagnosed in post-operative care and require local
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radiologically and a very low complication rate. 54 For further evaluation, more comparative long-term studies are needed. Post-operative care Our post-operative protocol consists of full weight-bearing mobilisation in a post-operative shoe for six
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implanted through a lateral, trans-malleolar approach. Post-operative care usually includes the application of a below-knee walking cast for six weeks associated with immediate weight bearing as tolerated, followed by a physiotherapy programme to optimise
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and less morbidity. At our institution, we created an integrated geriatric-orthopaedic unit devoted to the post-operative care of elderly patients undergoing elective as well as non-elective orthopaedic procedures (Integrated Geriatric
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functional outcomes at six weeks. 51 However, long-term outcome studies show equivocal results. 52 , 53 The review of the data favours a cemented femoral stem. 13 Post-operative care Aggressive pain management, multi-modal VTE
These authors contributed equally to this work
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These authors contributed equally to this work
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, as mentioned earlier, there still is no consensus as to post-operative care. For instance, many doctors allow full weight-bearing directly after surgery and so on. Conclusion Long negligence of MRL created scarcity of information regarding
